title: Tissue motion annular displacement of the mitral valve using two-dimensional speckle tracking echocardiography predicts the left ventricular ejection fraction in normal children.
abstract: BACKGROUND
  The gold standard for determining the left ventricular ejection fraction is cardiac magnetic resonance imaging. Other parameters for determining the ejection fraction such as M-mode echocardiography are operator-dependant and often inaccurate. Assessment of the displacement of the mitral valve annulus using two-dimensional speckle tracking echocardiography may provide an accurate and simple method of determining the left ventricular ejection fraction in children.
  
  
  METHODS
  We retrospectively studied 70 healthy 9-year-old children with no history of cardiovascular disease who had been assessed using cardiac magnetic resonance imaging and two-dimensional transthoracic echocardiography. Mitral displacement was determined using the tissue motion annular displacement (TMAD) feature of Philips QLAB version 9. The midpoint displacement of the mitral valve was calculated, and the predicted left ventricular ejection fraction was compared with magnetic resonance imaging-derived and M-mode-derived ejection fractions.
  
  
  RESULTS
  The mean ejection fraction derived from magnetic resonance imaging (64.5 (4.6)) was similar to that derived from the TMAD midpoint (60.9 (2.7), p = 0.001) and the M-mode (61.9 (7), p = 0.012). The TMAD midpoint correlated strongly with the magnetic resonance imaging-derived ejection fraction (r = 0.69, p < 0.001), as did the predicted fraction (r = 0.67, p < 0.001). The M-mode ejection fraction showed a poor linear correlation with both magnetic resonance imaging-derived and TMAD-derived fractions (r = 0.33 and 0.04, respectively).
  
  
  CONCLUSIONS
  TMAD of the mitral valve is a simple, effective, and highly reproducible method of assessing the ejection fraction in normal children. It shows a strong linear correlation with magnetic resonance imaging-derived ejection fraction and is superior to M-mode-derived ejection fractions.
authors.affiliation: 1Institute of Developmental Sciences,Human Development and Health Academic Unit,University of Southampton,Southampton,United Kingdom.
authors.forename: David E
authors.initials: DE
authors.lastname: Black
authors.affiliation: 1Institute of Developmental Sciences,Human Development and Health Academic Unit,University of Southampton,Southampton,United Kingdom.
authors.forename: Jen
authors.initials: J
authors.lastname: Bryant
authors.affiliation: 2Pediatric Cardiology and Cardiothoracic Radiology,University Hospital Southampton NHS Foundation Trust,Southampton,United Kingdom.
authors.forename: Charles
authors.initials: C
authors.lastname: Peebles
authors.affiliation: 1Institute of Developmental Sciences,Human Development and Health Academic Unit,University of Southampton,Southampton,United Kingdom.
authors.forename: Keith M
authors.initials: KM
authors.lastname: Godfrey
authors.affiliation: 1Institute of Developmental Sciences,Human Development and Health Academic Unit,University of Southampton,Southampton,United Kingdom.
authors.forename: Mark
authors.initials: M
authors.lastname: Hanson
authors.affiliation: 2Pediatric Cardiology and Cardiothoracic Radiology,University Hospital Southampton NHS Foundation Trust,Southampton,United Kingdom.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Vettukattil
mesh_terms: D002648:Child; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006352:Heart Ventricles / Q000033:anatomy & histology / Q000000981:diagnostic imaging*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008943:Mitral Valve / Q000033:anatomy & histology / Q000000981:diagnostic imaging* / Q000502:physiology; D015203:Reproducibility of Results; D013318:Stroke Volume; D016277:Ventricular Function, Left